The need for immune evaluation prior to thymosin-containing chemoimmunotherapy for melanoma

In an attempt improve the response to BCG or BCG + DTIC therapy in Stage IIIB melanoma patients, we added thymosin treatment with repeated doses of 4 mg/m² or 40 mg/m². Twenty-eight patients were clinically and immunologically evaluable. Pretreatment immunological evaluation consisted of determination of delayed-type hypersensitivity to recall antigens, enumeration of E-rosettes in blood, and measurement of blood lymphocyte response to phytohemmagglutinin (PHA) and concanavalin A (Con-A). The disease-free interval was correlated with thymosin dose and parameters of immunocompetence. Immunocompetent melanoma patients treated with a high thymosin dose and BCG relapsed earlier than those treated with a low thymosin dose and BCG. Thus, 72% of the melanoma patients who had a PHA SI≥50 and were treated with 4 mg thymosin/m², were disease-free at 9 months, compared with only 31% of those treated with 40 mg/m² (P=0.02). When the dermatophytin delayed hypersensitivity response (>10 mm induration) was used as a parameter of immunocompetence, 86% of the patients treated with 4 mg/m², were disease-free at 9 months, as against 28% of patients treated with 40 mg thymosin/m² (P=0.07). None of the immunoincompetent patients on high thymosin dose relapsed (0/3). The results suggest that while a high thymosin dose (40 mg/m²) may be detrimental to immunocompetent patients, it may have a beneficial effect in immunoincompetent patients. A low thymosin dose is probably not detrimental to immunocompetent melanoma patients in this study. Monitoring of the immune status prior to and during the use of thymosin in cancer immunotherapy is mandatory.